Older Person Symposium Flashcards
What is the life course of a dentition?
primary > secondary > partially dentate > edentulous
What is the impact of ageing and systemic disease to dental care?
- A population at an increased risk of oral disease
- Polypharmacy
- Impaired ability to co-operate
- Access -moving and handling
- Medical conditions complicate the provision of dental treatment
- Medical conditions contraindicate the provision of dental treatment
What are the effects of lichen planus in older people?
autoimmune
- Discomfort when eating
- Difficulty in performing oral hygiene
- Risk of malignant transformation
- Management of disease cannot just stop because they have dementia
- Can the Oral Medicine Consultant perform domiciliary care?
- Systemic disease and polypharmacy may contraindicate certain therapies
What are the issues with head and neck cancer in older people?
Present with more advanced disease at assessment
o Delay in diagnosis
o Symptoms unable to be communicated o Lack of attention paid
o Mis diagnosis
* Those who have undergone previous oncological care
o Surgery
o Radiotherapy
Which are the key teeth to retain for QoL?
- Occluding pairs of teeth
- Number of teeth
- Attempt to retain anterior teeth
What are tasks older people struggle with?
- Mobility → Stairs, Getting to the shops
- Dexterity → making a cup of tea , Brushing teeth
- Communication → sight and hearing → isolation
What do older people value
- Company and relationships
- Time
- A desire to contribute to society
- Someone listening
What is dementia and what does it affect?
Dementia is a syndrome – usually of a chronic or progressive nature
* Deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.
- It affects:
- Memory
- Thinking
- Orientation
- Comprehension
- Calculation
- Learning capacity
- Language
- Judgement
How does dementia happen and what is it characterised by?
Dementia is an acquired progressive loss of cognitive functions, intellectual and social abilities
Severe enough to interfere with daily functioning,
Characterized by:
* Amnesia (especially for recent events),
* Inability to concentrate,
* Disorientation in time, place or person,
* Intellectual impairment
What is the cause of alzheimers and what are the distinctive features?
Cortical shrinkage (esp. hippocampus), β-amyloid plaques, tau tangles
Features: STML, aphasia, activity confusion, mood swings, withdrawal
What are the associated factors with dementia?
- Age
- Gender – Women >Men
- Head Injury
- Lifestyle:
Increased risk = Smoking, hypertension, low folate and high blood cholesterol Reducing risk = physical, mental and social activities - Genetic – Abnormalities on chromosome 1, 14 or 21
What is vascular dementia and what is it caused by?
what are the distinctive features
Cause: Stroke(s), small vessel disease, linked to hypertension & diabetes
Features: Sudden memory issues, visuospatial issues, seizures, anxiety
What is dementia with lewy bodies?
what are the distinctive features?
Lewy protein deposits in brain (like Parkinson’s)
Features: STML, fluctuating cognition, hallucinations, motor/speech issues
What is frontotemporal dementia?
what are distinctive features of frontotemporal dementia?
Frontal lobe degeneration (TDP-43, Ubiquitin protein)
Features: Personality/behavioural change, language impairment, repetition/mutism
What are rarer forms of dementia?
- HIV – related genitive impairment
- Parkinson’s disease
- Corticobasal degeneration
- Multiple Sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
What are early stage symptoms?
- Loss of short-term memory
- Confusion, poor judgement, unwilling to make decisions
- Anxiety, agitation or distress over perceived changes
- Inability to manage everyday tasks.
- Communication problems – a decline in ability or interest in talking, reading and writing.
What are middle stage symptoms?
- More support required, including reminders to eat, wash, dress and use the lavatory;
- Increasingly forgetful and may fail to recognise people;
- Distress, aggression, anger, mood changes – frustration;
- Risk of wandering and getting lost, leaving taps running, gas unlit, cooking unattended or forgetting to light the gas;
- May behave inappropriately e.g. Going out in nightclothes;
- May experience hallucinations, throw-back memories.
What are late stage symptoms?
- Inability to recognise familiar objects, surroundings or people – but there may be some flashes of recognition.
- Increasing physical frailty, may start to shuffle or walk unsteadily, eventually becoming bed/wheelchair confined.
- Difficulty eating and sometimes swallowing, weight loss.
- Incontinence and gradual loss of speech.
- Symptoms are progressive and irreversible.
What is used to diagnosis and measure dementia?
- Dementia screen to eliminate treatable causes - FBC, U&E’s, kidney, liver and thyroid function tests
- Glucose, serum B12, Folate and Calcium, C-Reactive Protein and Urinalysis
- If indicated - Syphilis serology, autoantibody screen, serum cholesterol and CT
- Neurological examination and detailed cognitive testing (MMSE).
What is used for cognitive testing?
- Mini-mental State Examination ( Folstein)
- Blessed Dementia Scale
- The Montreal Cognitive Assessment (MoCA)
- Single Neuropsychological Tests:
Clock draw, Delayed word recall, Category Fluency - Combined single tests
7 minute screen, IQCODE, AD8 Dementia Screening
What are the pros and cons of MMSE?
Pros - well known, easy to administer, samples range of cognitive functions, test-re-test ans inter rater availbility
Cons - only 3 words to be remembered on recall (not sensitive to mild impairment), old, non-standardised time between registration and recall, not szensitive in testing frontal lobe
What is treatment of dementia?
No cure (surgical, pharmacological, behavioural)
Counselling delays care admission
Aspirin & Cardiac Risk Control: Helps vascular dementia
NSAIDs, Vitamin E, Ginkgo Biloba: May slow progression
What are the drug treatments of dementia?
Anticholinesterases (Donepezil, Galantamine, Rivastigmine): Mild-moderate AD
Continue until ineffective or MMSE <10
Vascular Dementia: Cerebrolysin
What is drug treatment for vascular dementia?
cerebrolysin
